Introduction

In recent years, with global economic and social development, people’s expectations of their jobs have increased beyond basic survival. They are looking for more comfortable work environments, equitable compensation, comprehensive protection measures, and fair treatment [1]. However, in psychiatric nursing, these needs are often overlooked. Patients with psychiatric disorders often face challenges such as emotional instability, abnormal behavior, and other issues. Consequently, psychiatric nurses need to remain vigilant and patient in their roles [2]. Moreover, they must handle emergency situations, such as dealing with aggressive behavior and suicidal tendencies among patients, which can significantly strain their psychological resilience [3]. More importantly, psychiatric nurses often lack sufficient social support [4, 5]. Research indicates that there is a prevalent negative perception of psychiatric care among healthcare professionals [6, 7]. The combination of high-pressure environments and negative perceptions may result in psychiatric nurses feeling undervalued and unrecognized, subsequently affecting their job satisfaction and mental well-being. Therefore, addressing the perception of decent work among psychiatric nurses has become an urgent issue requiring attention.

In June 1999, Mr. Juan Somavia, the director-general of the International Labour Organization (ILO), introduced the concept of “decent work” for the first time at the 87th International Labour Conference. He defined it as productive work for everyone, ensuring conditions of freedom, equity, security and human dignity [8]. Duffy further explained decent work as including physically and interpersonally safe working conditions, access to health care, adequate compensation, hours that allow for free time and rest, and organizational values that complement family and social values [9]. Currently, the concept of decent work has gained significant attention across various sectors, including healthcare, serving as a guiding principle for promoting individual well-being. A wealth of international research indicates that psychiatric nursing is a demanding and highly stressful profession [10]. Psychiatric nurses provide care for patients with severe mental health issues such as depression, anxiety, bipolar disorders, and other disorders. Their responsibilities involve managing patients’ emotional fluctuations, abnormal behaviors, and cognitive impairments amidst the potential threat of violence or physical harm. These complex working conditions may impact psychiatric nurses’ perceptions of decent work. Moreover, past research has shown that decent work impacts individuals’ physical and mental health and is associated with nurses’ burnout and turnover intentions [11, 12]. Therefore, it is crucial for psychiatric nurses to perceive their work as decent.

Social support plays a crucial “buffering” and “protective” role in individuals’ perceptions of decent work. Social support refers to the material or emotional assistance individuals perceive from sources such as family, friends, colleagues, partners, and associations [13]. Numerous studies and reviews have suggested that social support has a significant protective effect on nurses’ occupational health [14]. The more social support individuals receive, the fewer psychological health issues they report [15]. Additionally, a study conducted among Chinese workers revealed a positive correlation between social support and decent work [16]. These studies emphasize the importance of social support in enhancing decent work. For psychiatric nurses, long-term care for mental health patients can lead to emotional exhaustion, trauma, incidents of aggression, anxiety, violence, depression, fatigue, and burnout [17]. Social support not only implies receiving care and assistance from colleagues and supervisors at work but also support from the community and family outside of work. This support can help psychiatric nurses feel more respected and acknowledged, thereby alleviating the difficulties they face.

In addition to social support, the experience of an imbalance between effort and reward may also significantly influence nurses’ perceptions of decent work. Effort-reward imbalance refers to the disparity between the efforts made in the job (e.g., demands, obligations) and the rewards received (e.g., salary, recognition, job security) [18]. This imbalance can result in stress and long-term health issues, particularly among nurses working in psychiatric institutions who often need to invest additional emotional resources, such as dealing with challenging patient groups and facing trauma and violence from patients [19]. However, despite the significant emotional efforts exerted by psychiatric nurses, their income is relatively low [20, 21]. Therefore, the work pressure faced by psychiatric nurses may originate not only from the complexity and high demands of the job but also from economic constraints.

Psychological work theory (PWT) provides a framework for exploring factors influencing decent work. According to the PWT, decent work can enhance individuals’ work fulfillment and well-being by meeting their survival, social connection, and self-determination needs [22]. Marginalization and economic constraints serve as antecedents affecting individuals’ ability to obtain decent work, while social support plays a crucial moderating role [23]. Psychiatric nurses often face negative perceptions from society and other healthcare professionals, which may contribute to a lack of social support and financial pressure at work, thus influencing their perception of decent work [6, 24].

Although the importance of decent work has been widely discussed, research on its influencing factors remains limited. Currently, various factors such as economic conditions, marginalization, work volition, career adaptability, workplace climate, and social support are considered key influencing factors and moderating variables [25]. For instance, some studies have indicated that social support moderates the prediction of subjective social status regarding work volition and decent work [16]. However, the importance of social support and effort-reward imbalance is still relatively underemphasized, particularly in psychiatric healthcare. Although there is existing research on decent work among registered nurses and migrant nurses [26, 27], research specifically focused on psychiatric nurses is distinctly lacking. Therefore, this study aimed to investigate the current status of decent work among psychiatric nurses and analyze its influencing factors, to provide a reference for the formulation of mental health nursing policies and promote fair and dignified working environments for psychiatric nurses.

Methods

Study design

This study employed a cross-sectional research design, and the research report followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement.

Participants

The research was conducted at a tertiary Grade A psychiatric hospital in Hangzhou, Zhejiang Province, China, in February 2024. A cluster sampling method was utilized, with nurses from the hospital as the study participants.

The sample size was determined using the G-Power 3.1.96 linear multiple regression algorithm. With an effect size of 0.15, an α value of 0.05, a regression coefficient of 0.05, and an anticipated power (1 - β) of 0.95, this study included 21 variables: 10 sociodemographic characteristics and 11 dimensions related to the scale. The minimum required sample size was calculated to be 226 nurses, considering a 20% rate of invalid questionnaires, a minimum of 249 nurses were needed to meet the minimum sample size requirement.

The inclusion criteria were as follows: (1) registered psychiatric nurses with more than one year of hospital experience and (2) voluntary participation with informed consent. The exclusion criteria included (1) nurses on leave, (2) interns or trainees, and (3) administrative or logistical nursing staff.

Questionnaires were distributed to 410 nurses meeting the inclusion criteria. Of these, 390 nurses responded, resulting in a response rate of 95.12%. However, 32 respondents provided irregular responses, such as repeating numbers (e.g., 12,121,212, 11,111,111). After excluding these irregular responses, a total of 358 questionnaires were considered valid, resulting in an effective response rate of 91.79%.

Instruments

Nurse demographic information

Demographic information included gender, age, educational background, psychiatric nursing experience, professional title, marital status, parenthood status, income, job category, and night shift schedules.

Effort-reward imbalance questionnaire (ERIQ)

This study employed a locally adapted Chinese version of the Effort-Reward Imbalance questionnaire to conduct an in-depth investigation into the effort-reward status among psychiatric nurses. Originating from Siegrist’s research [28], the questionnaire was translated into traditional Chinese characters by scholar Cheng [29]. The simplified Chinese version was later translated by scholar Li, with its measurement reliability and validity widely recognized [30]. The questionnaire encompasses two core dimensions, “effort,” and “reward,” comprising a total of 17 items. Each item is rated on a Likert scale ranging from 1 to 5. The “effort” dimension has 6 items, with total scores ranging from 6 to 30. The “reward” dimension contains 11 items, with total scores ranging from 11 to 55. Referring to existing literature, we calculated the effort-reward ratio (ERR) to assess the imbalance between effort and reward. ERR is calculated as (effort score/reward score) × (11 /6), where 11 /6 corrects for discrepancies caused by inconsistent entries on the scales [31]. The higher the ERR, the more serious the imbalance. In this study, the Cronbach’s α coefficient for the effort and reward subscales were 0.799 and 0.861, respectively.

Social support rating scale (SSRS)

In this study, we used the Social Support Rating Scale to measure the social support status of psychiatric nurses. Developed by Chinese scholars [32], has been widely used in China and has demonstrated good reliability and validity. The scale comprises three dimensions: objective support (items 2, 6, and 7), subjective support (items 1, 3, 4, and 5), and support utilization (items 8, 9, and 10). Items 1–4 and 8–10 are scored on a 4-point Likert scale, with each item rated from 1 to 4. Item 5 is scored from A to D, with each option assigned a score from 1 to 4. Items 6 and 7 are scored as 0 if the response is “no source,” while if there are multiple sources, each source is assigned a score. The Cronbach’s α coefficient for this scale in our study was determined to be 0.852.

The decent work perception scale (DWPS)

This study used the Decent Work Perception Scale to assess the perception of decent work among psychiatric nurses. Developed by Chinese scholars, this scale has been widely employed within the nursing community [33]. The scale comprises five dimensions—work rewards, work position, work atmosphere, work development, and work recognition—with a total of 16 items. Each item is rated on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree), resulting in a minimum score of 16 and a maximum score of 80. Higher scores indicate a stronger perception of decent work. In our study, the Cronbach’s α coefficient for this scale was determined to be 0.946.

Data collection

The data collection for this study was conducted through electronic questionnaire surveys, with the research team disseminating electronic questionnaire links to nurses. The questionnaire comprised introductory instructions, demographic information, and variable scales. The introductory section emphasized the questionnaire’s purpose, guiding principles for answering questions, voluntary participation, and instructions on attention and interpretation. Before the study began, the researchers conducted comprehensive training for the three surveyors, emphasizing the study’s content, objectives, significance, and instructions for completing the questionnaire. Standardized promotional and introductory statements were provided to the surveyors. One researcher provided quality supervision during the data collection process. To mitigate social desirability bias, the research was conducted anonymously, with measures in place to ensure one submission per account, device, and IP address.

Data analysis

Data were analyzed using IBM SPSS 26.0. Descriptive statistics were employed to determine the demographic characteristics of the nurses and the mean values of the variables. Independent sample t-tests and one-way analysis of variance (ANOVA) were utilized to examine differences in demographic characteristics among variables. Pearson correlation analysis was conducted to assess the relationships between variables. Variables showing significant results in the independent sample t tests, ANOVA, and correlation analyses were further explored using stepwise regression analysis to identify influencing factors. A significance level of p < 0.05 was considered statistically significant.

Results

Participant characteristics

The average age of the psychiatric nurses surveyed in this study was 36.50 ± 8.33 years. Females dominated the sample, accounting for 91.6%, while there were significantly fewer males, accounting for 8.4%. The highest proportion of respondents reported a monthly income ranging from 5000 CNY to 9999 CNY (approximately 700 to 1400 USD), accounting for 56.4%. Regarding educational background, the majority (92.2%) held a bachelor’s degree. Among the participants, 72.1% were married, and 69.6% reported having children. The most common range for psychiatric nursing experience was between 5 and 15 years, representing 57.8% of the respondents. The predominant professional title was registered nurse (52.1%). Most participants (66.2%) were permanently employed. Additionally, 43.6% reported having fewer than 5 night shifts per month. See Table 1. The scores for decent work among the samples are also provided in Table 1, indicating variations in decent work scores based on different psychiatric nursing experience, professional title, job category, and monthly night shift frequency. In addition, the scores and demographic differences in social support and effort-reward imbalance are shown in Table S1.

Table 1 Sociodemographic characteristics of the sample (N = 358)
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Descriptive statistics of the study variables

This study examined the scores of decent work, social support, and professional quality of life among psychiatric nurses. The mean score for decent work was 55.69 ± 10.42. The mean score for social support was 41.37 ± 8.45. The effort-reward imbalance ratio was 0.92 ± 0.26 (see Table 2).

Table 2 Correlation of decent work, social support, and effort-reward imbalance (N = 358)
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Correlations

This study analyzed the relationships among decent work, social support, and effort-reward imbalance among psychiatric nurses. The results revealed that decent work was positively correlated with social support (r = 0.360, p < 0.001) while negatively correlated with effort-reward imbalance (r = -0.584, p < 0.001). Additionally, social support was negatively correlated with effort-reward imbalance (r = -0.353, p < 0.001). See Table 2.

Regression analyses

As shown in Table 3, multiple linear regression analyses were conducted with decent work scores as the dependent variable, and psychiatric nursing experience, professional title, job category, and monthly night shift frequency as predictor variables, along with social support and effort-reward imbalance scores as predictors. In Step 1, we evaluated the relationship between sociodemographic variables and decent work. We found that the variable “Psychiatric nursing experience” (< 5 vs. >25 years) significantly influenced the perception of decent work (β = -0.212, p = 0.025), explaining 4.3% of the model’s variance. After including the social support variable in Step 2, the explained variance of the model increased to 23.2%. Social support exhibited a significant positive impact on the perception of decent work (β = 0.462, p < 0.001). Furthermore, after including social support, the impact of ‘Psychiatric nursing experience’ remained significant but showed some changes. Specifically, those with less than 5 years of work experience exhibited significantly lower perceptions of decent work compared to those with 5–15 years (β = -0.241, p = 0.003), 16–25 years (β = -0.253, p = 0.007), and more than 25 years (β = -0.276, p < 0.001). In Step 3, with the addition of the effort-reward imbalance variable, the explained variance of the model further increased to 40.2%. The effort-reward imbalance had a significant negative impact on the perception of decent work (β = -0.458, p < 0.001). Meanwhile, social support continued to have a positive impact on the perception of decent work (β = 0.259, p < 0.001). Even after including these two variables, the impact of having less than 5 years of work experience compared to 16–25 years (β = -0.164, p = 0.046) and more than 25 years (β = -0.157, p = 0.040) remained significant. The adjusted R-squared increased from 4.3% in Step 1 to 40.2% in Step 3, indicating that the predictors included in the model explained a substantial portion of the variance in the outcomes.

Table 3 Regression analysis results
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Mediation analysis

As shown in Fig. 1, the study findings indicate that ERI has a significant negative direct effect on both decent work (β = -0.521, p < 0.001) and social support (β=-0.353, p < 0.001). Social support positively affects decent work (β = 0.176, p < 0.001) and mediates the relationship between ERI and decent work (β=-0.062, Bootstrap 95% CI: -0.107, -0.023). Social support partially mediates the relationship between ERI and decent work, accounting for approximately 10.62% of the total effect(see Table 4).

Table 4 The impact of effort-reward imbalance on nurses’ perception of decent work: a mediation analysis of Social Support
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Fig. 1
figure 1

The model of effort-reward imbalance, perception of decent work, and social support

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Discussions

This study aimed to assess the current status of decent work among psychiatric nurses and explore its influencing factors. The correlation between decent work and social support was positive, while it was negative for effort-reward imbalance. The factors influencing the perception of decent work included psychiatric nursing experience, social support, and effort-reward imbalance.

The results of this study indicate that psychiatric nurses scored 55.69 ± 10.42 in terms of decent work, similar to the results of previous surveys conducted among registered nurses in China [12]. Despite facing various challenges in psychiatric work, nurses receive systematic training in professional learning and practice, acquiring significant experience in handling issues related to mental health patients [34]. This professional competence enables them to better cope with work difficulties, thereby maintaining a perception of decent work. Furthermore, exposure to patients with mental and psychological issues may heighten psychiatric nurses’ focus on self-protection and emotional management [7]. The ability for emotional management may also contribute to preserving their perception of decent work [35].

Furthermore, the results indicate that psychiatric nursing experience significantly influences the perception of decent work among psychiatric nurses. Overall, nurses with less than 5 years of work experience reported significantly higher perceptions of decent work compared to those with more than 25 years of experience. This finding is contrary to previous research [26]. This discrepancy may be because nurses with longer working experience might feel that their career development is limited or that promotion opportunities are insufficient, which could impact their perception of decent work [36].

The study findings also showed that social support significantly influences decent work. This finding aligns with previous surveys conducted among emerging adults in South Korea, emphasizing its crucial role in enhancing the perception of decent work [37]. Support from colleagues, supervisors, and the community can help nurses recognize their professional value and social contributions, thereby enhancing their perceived social status and professional recognition and fostering their perception of decent work [38]. Additionally, social support can provide emotional and practical assistance and encouragement to nurses, help alleviate work stress, enhance job satisfaction, alleviate burnout, and further enhance their perception of decent work [39]. Thus, establishing and strengthening social support networks is vital for enhancing the perception of decent work among psychiatric nurses.

Finally, this study revealed that effort-reward imbalance is another important factor influencing decent work among psychiatric nurses. Additionally, social support plays a mediating role between effort-reward imbalance and decent work. This is consistent with the principles of psychological work theory, which emphasize the critical role of the work environment and incentives in maintaining the dignity and decency of nurses [22]. In psychiatric nursing, where nurses often deal with a unique patient population, high emotional involvement in work is needed, making the balance between effort and reward particularly crucial. When nurses feel that their efforts are inadequately rewarded, such as receiving lower income or facing economic constraints, their perception of decent work may decrease [23]. Notably, an imbalance between effort and reward may also lead to nurses experiencing negative emotions and psychological states, potentially resulting in feelings of unfairness and disrespect, which can affect their job performance and attitude [40]. However, the presence of social support can mitigate these negative effects. Social support from colleagues, supervisors, and the organization can provide emotional and practical assistance, helping nurses cope with stress and perceive their work environment more positively. These findings highlight the significant impact of effort-reward imbalance on decent work and underscore the importance of healthcare institutions and managers in providing social support, ensuring that nurses’ work experience and dignity are preserved.

This study holds significant importance in safeguarding the working rights of psychiatric nurses and underscores the importance of upholding their dignity in labor. First, healthcare institutions should provide adequate resources and support [41], such as increasing the number of nursing staff, fostering a positive work atmosphere, and offering necessary training and education. This will ensure that psychiatric nurses can perform their duties efficiently and safely. Furthermore, society should increase its attention and respect for psychiatric nurses, reducing discrimination and biases toward the profession and its institutions [42]. This will help in create a more comfortable, safe, and dignified working environment for nurses. Second, incentive mechanisms are vital for maintaining decent work. Healthcare institutions should establish fair salary structures and reward systems, ensuring that nurses receive fair compensation for their hard work [36]. For instance, recognizing outstanding nurses, organizing skill competitions, and providing advancement opportunities can encourage professional development among nurses. These incentive mechanisms not only contribute to enhancing nurses’ job satisfaction and sense of dignity but also attract more talent to join the psychiatric nursing workforce, thereby enhancing the overall level of nursing care.

Limitations

Although this study has made significant discoveries, it also has some limitations. First, the investigation was conducted solely within a single healthcare institution and lacked diverse sample sources, which may limit the generalizability and applicability of the research findings. Second, the study used a cross-sectional survey design, which precludes the assessment of temporal changes and long-term trends, thereby precluding causal inferences. Finally, despite measures such as anonymization being used to protect respondent privacy, the influence of social desirability bias cannot be entirely eliminated, posing a risk of information bias. Therefore, future research could consider employing multicenter, longitudinal, qualitative studies and further explore other potential influencing factors to enhance the credibility and applicability of the research conclusions.

Conclusion

In this study, we found that years of work experience, social support, and effort-reward imbalance are significant factors influencing the perception of decent work among psychiatric nurses. Long-term work experience contributes to improving nurses’ perception of decent work. Effort-reward imbalance has a direct negative impact on decent work, while social support has a direct positive impact on decent work. Future research could use other research methods to explore additional potential influencing factors or develop targeted interventions based on this study’s findings to enhance psychiatric nurses’ perception of decent work.